Dysmenorrhoea and heavy menstrual bleeding — branching viva

Station opening

Examiner: "A 15-year-old presents with painful periods that began about a year after menarche. Define dysmenorrhoea and tell me why primary dysmenorrhoea begins at that point and not at the first period." ^[1]

Strong candidate (must-hit)

• Defines dysmenorrhoea as cyclic pelvic pain with menstruation. Explains that primary dysmenorrhoea begins only once ovulatory cycles establish, typically 6 to 12 months after menarche, because the secretory-phase progesterone of an ovulatory cycle primes the endometrium to synthesise prostaglandins (PGF2α, PGE2) and leukotrienes — the mediators that drive myometrial contraction, vasoconstriction and uterine ischaemia. The very first, anovulatory periods carry a smaller prostaglandin load, so they are often painless. ^{[1] [6]}

Weak candidate

• "It is period pain, and it starts from the first period." ^[1]